Opinion page editor Rick Holmes and other writers blog about national politics and issues. Holmes & Co. is a Blog for Independent Minds, a place for a free-flowing discussion of policy, news and opinion. This blog is the online cousin of the Opinion
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Opinion page editor Rick Holmes and other writers blog about national politics and issues. Holmes & Co. is a Blog for Independent Minds, a place for a free-flowing discussion of policy, news and opinion. This blog is the online cousin of the Opinion section of the MetroWest Daily News in Framingham, Mass. As such, our focus starts there and spreads to include Massachusetts, the nation and the world. Since successful blogs create communities of readers and writers, we hope the \x34& Co.\x34 will also come to include you.

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By Rob Meltzer

April 13, 2014
6:18 p.m.

From Rick’s post, it appears it is necessary to take a step back here and discuss basics. First of all, the statute that created the current disastrous health care insurance scheme is the Affordable Care Act. The program, which is the Act plus regulation plus opinion plus enforcement is collectively “Obamcare” which is not the same thing as the Affordable Care Act.

I don’t think most non-lawyers grasp that when Pelosi said that we wouldn’t know what was in the Act until it was implemented, she wasn’t being flip, or ironic or funny. Literally, the Act was and is meaningless.† As some may recall, I read the bill back in 2010, and as I commented at the time, the statute doesn’t do anything but create regulatory power and a framework of aspirations. This is a reflection of the fact that this country has become a regulatory/administrative state rather than a statutory state.† If you think about it, the Affordable Care Act didn’t need to be 1500 pages. It could have been 3 sentences long: “1. Unemancipated minors up to age 26 shall be eligible to be carried on their parents’ health insurance. 2. No insurance company shall deny anyone health insurance on the basis of a pre-existing condition. 3. Anyone who can’t afford health insurance will get a welfare check to cover the difference between what they can afford and what the policy costs.” Simple. But that’s not what happened. Instead, the 1500 pages if full of pork stuffed in which gives all kinds of goodies to all kinds of people, and good luck trying to figure out who got what and how.

So what happens when a bill like the Affordable Care Act is written? Well, at that point, the Executive Branch starts fleshing out the program to effectuate the Act, and whole new layers of special interests throw in their wish list items, until an unclear 1500 page bill is inflated by about 20,000 pages of federal regulation. And then, what happens next? Those affected by the Act and regs, like drug companies, hospitals, insurance companies, medical device companies and pharmacies, not to mention their banks and venture capitalist bankers, begin reading through this mess. And when they can’t figure out what this stuff means, they write letters to the Executive Branch asking for explanation and clarification to avoid enforcement actions. so the Secretary sends out opinions and letters, which adds yet another level of gloss to the law. Thus, you soon have 1500 pages of statute, 20,000 pages of regulation, and 500,000 pages of advisory opinions.† And just for fun, you can already find a bibliography of about 5,000,000 pages of journal articles as academics debate what is in that law. And just wait until all of this hits the Courts.

So when weird things happen with Obamacare and anecdotal experience of patients, it is virtually impossible to trace back where this stuff comes from. It bothers Rick that you can’t nail down facts and statistics and the ins and outs of what has happened here and who has enrolled and what is true and what is not. But that’s the nature of a trainwreck. We’ll know its not working only when it goes off the rails and kills us all. The Democrats whistle past the graveyard and say the Republicans are just obstructionist. The Republicans say, when no one understands a law or what’s in it, you don’t wait until we’re all dead to fix the problem. You avoid the trainwreck by repeal. I recently observed a major Boston hospital that is treating people stacked up like cord wood in emergency room hallways because the insurance companies are not permitting costly overnight admissions. And a friend of mine who received a medical degree in Moscow many years ago has commented that already what is happening here reminds her of medical care as she knew it–in the Soviet Union. Is that what we want? Was that the goal?

As a hazard, I can’t help referring to books. If you want to understand what is happening here, read Regulation; a Primer, by Susan E. Dudley and Jerry Brito, the best overview of how a statute moves from idea to implementation. And then read the Affordable Care Act and the regulations, and then read the advisory opinions and the literature that is being spawned, and then maybe you can give us some facts about what is really in this law. And if no one knows what’s really it and what it means, why are we defending this as the paragon of social engineering?